Heather Dawn Brock, | |
307 Boatner Rd Ste 114, Eglin, FL 32542-1302 | |
(850) 883-9042 | |
Not Available |
Full Name | Heather Dawn Brock |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 307 Boatner Rd Ste 114, Eglin, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003574500 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363L00000X | Nurse Practitioner | 1-182636 (Alabama) | Secondary |
363LF0000X | Nurse Practitioner - Family | 11015727 (Florida) | Primary |
Entity Name | Santa Rosa Hma Physician Management, Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1447365366 PECOS PAC ID: 1658478532 Enrollment ID: O20070823000556 |
Entity Name | Ibrahim Heart Clinic Pllc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1629511035 PECOS PAC ID: 4688958648 Enrollment ID: O20170313000103 |
Entity Name | Premiercardia Pllc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1265015416 PECOS PAC ID: 3870998214 Enrollment ID: O20210823001639 |
Mailing Address | Practice Location Address |
---|---|
Heather Dawn Brock, 307 Boatner Rd Ste 114, Eglin, FL 32542-1302 Ph: () - | Heather Dawn Brock, 307 Boatner Rd Ste 114, Eglin, FL 32542-1302 Ph: (850) 883-9042 |
Carolyn Ann Space, CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 96 Mdg, 307 Boatner Road, Eglin, FL 32542 Phone: 850-883-9957 | |
Ms. Victoria Margaret Baker-janis, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 307 Boatner Rd, Suite 114, Eglin, FL 32542 Phone: 850-883-8600 |